The present invention is in the field of surgery and devices wherein a specific structure is adapted to be placed in or on a living body for diagnostic purposes. More specifically, the present invention relates to intrauterine ECG electrodes for monitoring a fetus during active labor.
During active labor, it is often desirable to continuously monitor certain physiological parameters that are indicative of the condition of the fetus in utero, such as fetal heart rate (FHR). This desirability has motivated the field to develop a variety of intrauterine devices for monitoring FHR, and other fetal physiological parameters (e.g., pH, oxygen tension, etc.) as more serious medical concerns for the fetus"" well being may indicate. Examples of such devices include Lumbardi (U.S. Pat. No. 4,501,276), Quedens et al. (U.S. Pat. No. 5,199,432) and Morrison et al. (U.S. Pat. No. 5,551,424), which all describe probes containing an ECG electrode for intrauterine application during active labor, and useful to monitor FHR. However, these electrode probe devices all require the implantation of the electrode into or through the skin (typically, the scalp) of the fetus. Though touted as minimally invasive, and though useful for their intended purpose, such trans-dermally implanted electrodes still present a risk of infection resultant from the lesion the electrode must necessarily make in the skin of the fetus.
To overcome this disadvantage, the field has been further motivated to provide intrauterine fetal monitoring probes that are less invasive than trans-dermal electrodes. For example, Gardosi (U.S. Pat. No. 5,634,459) discloses an intrauterine two sided probe for monitoring a fetus during labor. The Gardosi probe has an elongated body with a skin surface contact electrode on each of its sides, a fetal tissue contact electrode on one side and a maternal tissue contact electrode on the other side. Additionally, the Gardosi electrode has an inflatable balloon element at its distal end to assist in maintaining placement of the probe after it has been positioned, and a hollow passage through the interior of the elongated body for inflating the balloon.
Siker et al. (U.S. Pat. No. 5,425,362) also describe a fetal sensor probe for insertion within the uterus of a woman in active labor. The Siker probe includes a sheath which houses a flexible (spring steel) strip that biases the end of the Siker probe to have an outward curvature relative to the fetus it contacts in the preferred embodiment, or to be flat. The sensors on the Siker probe are encased within the sheath and do not directly contact the fetal tissue.
Another intrauterine fetal monitoring probe is disclosed by Van Dell et al. (U.S. Pat. No. 5,377,673). Van Dell discloses a probe comprising a laminate pad enclosing a light source, one or more sensors and a switch means. The pad is designed to be intra-cervically adhered using an adhesive to the skin of the fetus"" face or chest, or to be looped around an extremity. These methods of attaching the Van Dell probe can be relatively cumbersome to accomplish.
Although the above probe devices may be useful for their intended purposes, it would be beneficial in the field to have an alternative fetal monitoring probe electrode that is less invasive than the trans-dermal electrodes, which can provide an ECG wave form in addition to FUR data, and which is simple in design and economical to use.
The present invention is a disposable intrauterine fetal monitoring electrode assembly. The electrode assembly is for use with fetal monitoring equipment to accurately monitor fetal heart rate (FHR) during labor after the amniotic membrane has been ruptured. The assembly is a thin, flexible strip made of an insulating material with a metallic surface electrode fixed to each side of the strip. Electrical leads or wires separately connect the surface electrodes to the monitoring equipment. The flexible strip portion of the assembly is introduced into the vagina (e.g., during vaginal exam) and advanced through the dilated cervix between the maternal uterine tissue and the fetus"" head. The assembly may be held in place by surface features on either or both sides of the strip in combination with the pressure of the uterine sidewall against the electrode assembly.
The electrode assembly comprises a thin, flexible strip having two sides and two ends: an insertion end and a connector end. The material of the flexible strip is an electrical insulator. The insulating strip has two electrodes (or two sets of electrodes), one disposed on each of its sides. The inputs to many ECG machines usually require a minimum of three leads to provide a suitable monitor trace. However, as is known in the art, a two lead ECG electrode may be adapted to provide an appropriate input to an ECG monitor that requires a three lead input. See Heath, U.S. Pat. No. 4,494,552, disclosing a body tissue impedance simulating circuit to adapt a two lead ECG electrode to a three lead ECG monitor input. The electrodes may be disposed in various locations on the strip with a conductor leading from each electrode to the connector end of the strip where it is connected to its own electrical lead for connection to the input of the fetal monitoring equipment. An electrical connector is disposed at the connector end of the flexible strip.
The electrical connector is an insulating sheath containing electrical leads. At its distal end, the electrical connector is attached to the connector end of the insulating strip and adapted to connect the electrodes on both sides of the flexible strip to its respective electrical lead. This provides electrical continuity between each electrode and a separate electrical lead disposed within the insulating sheath of the electrical connector. The proximal end of the electrical connector is adapted to be attachable to an input of the fetal monitor equipment.
The flexible insulating strip of the electrode assembly serves as an insulator separating the electrodes on one side of the strip from those on the other side. The insulating strip may be made of any of a variety of flexible insulator materials to which a metal electrode may be fixed, such as rubber, latex and plastic. MYLAR(trademark) (DuPont de Nemours and Co., Delaware) is a commercially available polyester film that is a particularly desirable electrode assembly strip material, as it is possible to adhere or plate a conductive metal onto a MYLAR(trademark) strip. The plating of silver on to MYLAR(trademark) is already known in the art. However, any electrical conductor that can be fixed to the surfaces of the flexible strip may be adapted for use in the present invention, including stainless steel.
On one side, at the insertion end, a grip feature is fixed to the flexible strip. The purpose of the grip feature is to provide a means for inserting the electrode assembly through the cervical opening and into position between the tissue of the fetus and the uterine wall. The grip feature may be a pocket for releaseably receiving a stylet guide, or simply a finger grip to facilitate positioning the electrode assembly by hand. The flexible strip has a width ranging from about 0.5 cm to about 2.0 cm, and a length ranging from about 4.0 cm to about 10.0 cm.
A set of one or more electrodes are disposed on each surface of the flexible insulating strip. Either side of the insulating strip may have a plurality of electrodes disposed on that side. One set of electrodes of the electrode assembly are the reference electrodes, and the other set serve as the signal electrodes. One side of the insulating strip contacts the maternal tissue of the uterus and has the grip feature disposed at its insertion end. The other side of the flexible strip contacts the tissue of the fetus. The contact electrodes on the side of the flexible strip that interface with the maternal tissue serve as the reference electrodes. Conversely, the electrodes on the side of the flexible strip that interface with the fetal tissue serve as the signal electrodes.
The electrodes of the present invention are contact electrodes as opposed to the implant-type electrodes discussed above. A surface portion of the present contact electrodes interacts at the surface of the tissue it contacts, but does not impale the tissue as does an implant-type electrode. A consideration in the design of an electrode is minimization of the electrode-to-tissue contact impedance between the electrode and the tissue it contacts. Factors influencing contact impedance include the surface area of the electrode, how much of the electrode surface area securely contacts the tissue, and the conductivity or ease with which the electrode material conducts electricity. The flexible insulator strip of the present electrode assembly, especially a MYLAR(trademark) insulator strip with silver plated electrodes, is readily conformable to the surfaces it contacts in the present application. Additionally, the electrode-to-surface contact area and contact impedance of the electrode may be optimized in an assembly having a set of multiple electrodes on one or both sides of the insulator strip by selecting the best positioned electrode in the set, or to interconnect additional electrodes of a set on the one side to increase the effective surface area of the electrode.
To further reduce contact impedance, the tissue contacting surface of the electrodes may be coated with a conductivity enhancing material, such as is known in the art. The conductivity enhancing material may be applied to the electrode by any of a number of means known to one of ordinary skill in the art. Examples of electrode conductivity enhancing materials includes saline gels and chlorides of the desired conductive metal. Ibid.